The effect of kidney transplantation on left ventricular remodeling and global diastolic strain rate in end‐stage renal disease

Abstract

Background: Diastolic dysfunction is an early marker of cardiac pathology in end-stage kidney disease (ESKD) patients. The ratio of transmitral filling velocity (E) to early diastolic strain rate (E/e'sr) is a novel non-invasive marker of early left ventricular (LV) filling pressure obtained using two-dimensional speckle tracking echocardiography (2DSTE).Methods: In a prospective cohort of kidney transplant (KTX) recipients with echocardiograms performed pre-transplant we obtained repeat echocardiograms at 6 months following transplant. All echocardiograms were analyzed using 2DSTE where E/e'sr and global longitudinal strain were obtained. Paired tests were used to assess changes to cardiac structure and function following KTX.Results: A total of 33 patients were included in the study (mean age was 46.6 ± 13.7 years and 42% were males). The primary causes of ESKD in the cohort were glomerular disease (33%), hypertension (30%), and polycystic kidney disease (12%). The median (IQR) time spent on dialysis was 5.4 years [2.9, 7.7 years]. A reverse remodeling of the LV was observed following KTX as LV mass decreased (189.2 ± 57.5 g vs 171.1 ± 56.8 g, P = 0.014). LV filling pressure decreased as assessed by E/e'sr (103.7 ± 51.1 cm vs 72.6 ± 35.5 cm, P = 0.009). E to early diastolic mitral annular tissue velocity (E/e') did not change following KTX (9.9 ± 4.5 vs 10.3 ± 4.1, P = 0.54). Additionally, both LV internal diastolic and systolic diameter decreased significantly. Conclusion:Reverse cardiac remodeling following KTX was observed as improvements in LV mass and LV dimensions. LV filling pressure improved as assessed by E/e'sr decreased following KTX, whereas E/e' did not change.

Left atrial strain as a potential parameter to detect cancer therapy‐related cardiac dysfunction: An editorial commentary and systematic review

“…However, the sample size analyzed was small, and the prognostic role of LA dysfunction or abnormal LA strain (i.e., LA strain < 23%) before or after chemotherapy was not analyzed in this study 5 . Hence, while the findings of this study are promising and in agreement with previous studies (see Table 1, which shows a systematic review), 5–17 further larger studies should validate these results by analyzing the clinical relevance of an abnormal LA strain before and after chemotherapy and by validating the sensitivity and specificity of a relative decline of LA strain (> 10%, 15%, 20%, and 25%) to detect CTRCD.…”

“…In effect, an abnormal LA strain indicates a higher risk for a new‐onset AF, 18–22 thereby justifying the need for more intensive cardiac monitoring, such as a 5−7 day ECG Holter, rather than just clinical surveillance, to detect asymptomatic episodes of AF that could lead to a cardioembolic stroke. Therefore, according to previous studies on the potential use of LA strain to predict the risk of AF 18–22 and the novel findings of the study by Li et al., 5 along with other previous studies (see a systematic review in Table 1), 6–17 it is possible to state that LA strain is a promising parameter in the setting of CTRCD, which warrants further validation.…”

“…In this respect, recent studies have demonstrated the potential role of LA strain in determining the risk of AF in patients with cardiovascular (CV) risk factors and preserved LVEF 18–22 . By the way, many patients with cancer also have CV risk factors such as arterial hypertension or diabetes and preserved LVEF 1–17 . Hence, it is worth noting that using LA strain to predict the risk of AF in the context of CTRCD may be of high clinical relevance.…”

Left Ventricular Hypertrophy After Renal Transplantation: Systematic Review and Meta-analysis

“…Initially, 7416 references were identified. Forty-six studies, 16–61 involving 4122 participants with a mean age of 46.2 ± 7.6 y and a mean body mass index of 26.4 ± 10.3 kg/m 2 , met the inclusion criteria. Eleven studies were cross-sectional, and 35 were longitudinal.…”

The added value of left atrial strain in cancer‐therapy‐related cardiac dysfunction

“…Knowing the impact that LA functions has in detecting CTRCD the study by Lassen and colleagues has tested LA strain in the evaluation of CTRCD as a tool for early detection of myocardial damage induced by chemotherapy 9 …”